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Full text of "Medical Jurisprudence And Toxicology"

266                                              MEDICAL JURISPRUDENCE

a few cases, where the individual has been able to walk some distance, and
has performed some other volitional acts after receiving the injury. Strass-
man15 reports a case where a man was stabbed in the left fourth intercostal
space with a knife which, penetrating the thorax, caused a wound, " wide,
in the left ventricle. He lived for four days, and on the day following the
receipt of the wound he lifted heavy weights. Coats 1G reports the case of a
girl, ten years old, who survived nine days after receiving a penetrating
wound in the right auricle through the fourth costal cartilage on the right
side of the chest as the result of a fall on an iron railing. Magnus C.
Peterson 17 reports the case of a man, aged 26, who survived eighteen months
after a safety pin was thrust in his heart with a view to committing suicide.
The pointed end of the brass pin was protruding into the pericardial sac
from the left atrium on the surface of which it formed a shallow depression.
The pin, which was about 12 cm. in length and 1.2 mm. in diameter, pene-
trated the left atrium and curved over on the right side of the vertebral
column in a slightly downward direction. On the other hand, some cases
have been successfully treated by surgical operation. E. M. Freese18
describes a case of recovery from a stab wound through both ventricles of
the heart. A coloured man was stabbed at about 8 p.m. on the 2nd September
1920, and was taken to the Grant Hospital in half an hour. He was un-
conscious, the respirations were feeble and very shallow, and the pulse was
not perceptible, either in the radial or carotid artery. The pupils were
dilated, and the skin was bathed in cold perspiration. On examination a
wound, i" long, was revealed in the fourth intercostal space 2" to the left
of the sternum. On opening the chest the pericardium was filled by a clot
which produced almost a complete tamponade. When the clot was scooped*
out, the heart began at once to beat violently, spurting a stream of blood
on the anaesthetist and over the field. Recovery occurred after the wounds
were sutured. S. S. Sen 19 describes the case of a young Mahomedan male,
who was stabbed in a street and was at once brought to the General Hospital,
Rangoon. On opening the chest the pericardium was found to be cut, and
a large amount of blood-clot was removed from the pericardial sac. It was
then found that the weapon had also penetrated the left ventricle, where a
large blood-clot had fortunately prevented the escape of serious quantities
of blood, This clot was removed and the heart-muscle wound sutured with
fine catgut; the pericardium was also closed, and the wound in the skin
sutured in layers. The patient was treated on the usual lines for shock, and
he made an uneventful recovery.

It is possible that foreign bodies, such as bullets, sharpnel, or fragments
of shells, may remain embedded in the myocardium for months or years
without the production of symptoms. In such cases it is probable that the
original injury was relatively slight that the missile, by acting as a plug,
effectively checked any severe haemorrhage. Gilchrist20 describes two cases
in which missiles were found embedded in the muscle of the left ventricle
of the heart by X-ray examination thirteen years after wounding. Both men
were in good health and fit for active work.

Danger to life depends upon the nature of the wound. If it is small and
passes obliquely through the wall so as to act as a valve-like flap or if a
weapon happens to plug the orifice, life may be prolonged for some hours,
days or even months. On account of their thinner muscular walls, wounds

15.   Lehrb. der ger. Medicin, 1895; Dixomann, Forens. Med. and Toxic, Ed. VI, p. 222.

16.    Glasgow Med. Jour., 1891; Ibid., p. 232.

17.   Jour. Amer. Med. Assoc., May 11~ 1929, ID. 1599.

18.   Jour. Amer. Med. Assoe., Feb. 19, 1921, p< 520.

19.   Ind. Med. Gazette, Sep. 1931, p. 508 ; see also G. S. M. Wilson, Brit. Med. Jour.,
March 10, 1951, p. 511.

20.   Brit. Med. Jour., April 20, 1929, p, 723.